This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Hino, A. Articles by Katsumori, T. Search for Related Content PubMed PubMed Citation Articles by Hino, A. Articles by Katsumori, T.

(Stroke. 1998;29:2517-2521.)
© 1998 American Heart Association, Inc.

Original Contributions

Value of Repeat Angiography in Patients With Spontaneous Subcortical Hemorrhage

Akihiko Hino, MD; Masahito Fujimoto, MD; Tarumi Yamaki, MD; Yoshihiro Iwamoto, MD Tetsuya Katsumori, MD

From the Departments of Neurosurgery (A.H., M.F., T.Y., Y.I.) and Radiology (T.K.), Saiseikai Shigaken Hospital, Shiga, Japan.

Correspondence to Akihiko Hino, MD, Department of Neurosurgery, Saiseikai Shigaken Hospital, Ohashi 2-4-1, Ritto, Shiga 520-30, Japan.

Background and Purpose—Neuroradiological investigations do not disclose a source of bleeding in some patients with spontaneous subcortical hemorrhage. These patients may harbor undetected vascular malformations and may be at risk of rebleeding in the future. We investigated patients with subcortical hemorrhage with use of repeat angiography and MRI to determine the incidence of occult vascular malformations and the risk of bleeding during follow-up.

Methods—We reviewed a consecutive series of 137 patients with subcortical hemorrhage during a 10-year period (June 1987 through June 1997). If the patient was <65 years old and the first angiogram and/or MRI did not show a source of bleeding, repeat angiography was recommended. All angiographic and MRI studies were reviewed. The relationship between the identified bleeding source and clinical variables such as patient age, sex, and history of hypertension and the size and location of the hematoma were examined.

Results—One hundred seven patients (78%) underwent angiography on admission, 10 (7%) had immediate surgery for hematoma without angiography, and 20 (15%) had neither angiography nor surgery. Overall, an etiology for the hemorrhage was found in 55 cases (40%). Vascular malformations were common in young patients without preexisting hypertension. A second angiogram was obtained in 22 patients, and 4 arteriovenous malformations were demonstrated. Rebleeding at the site of the initial hemorrhage was not observed after a mean follow-up of 68 months.

Conclusions—Angiography performed acutely after hemorrhage may not demonstrate vascular malformations. Consideration should be given to repeat angiography in patients who do not have a specific cause for hemorrhage.

Key Words: angiography • cerebral arteriovenous malformations • intracerebral hemorrhage • vascular malformations